Low back pain is the top complaint I treat in my practice and is highly prevalent throughout our country and world. Pain in our backs is a high contributor to disability rates in our country as well as the increases we have seen in opioid use. Healthcare expenses are out of the roof paying for things such as imaging, medication, and surgery, all hoping to alleviate back pain.
Back pain is an ever-evolving disability that can be hard to understand. We now know that many factors affect pain and how we heal including our backgrounds, our jobs, our level of education, as well as our beliefs and knowledge of pain. All that to say, it can be hard to treat.
As research evolves, there have been some old ways of thought we have been able to debunk. Understand myths and taking a proactive approach to not fall into these beliefs can help patients and healthcare providers alike, tackle the treatment of low back pain altogether!
Bed rest was once considered the first line of treatment for anyone who underwent a back injury. While resting injured muscles can help decrease inflammation, I find most patients rest for too long, which can actually make your condition worse. Bed rest allows muscles to become stiff and weak, increasing our risk for further injury. Our discs hold nutrients like a sponge, and without movement, they can lose fluid.
Research shows that 1-2 days max of resting is all that is needed after an acute back injury. Get up. Walk your dog. Go to the store. Finding ways to move, even if you start small, is considered best practice when managing back pain.
Some people feel as though once they injure their back the first time, they are doomed to deal with it forever. Staying active, finding back healthy exercises, learning proper bracing and lifting techniques, avoiding nicotine, and eating healthy are all predictors of good spine health and can keep back pain away for good.
Allowing yourself to buy into this myth can actually keep you from feeling better overall. A person’s belief and mindset on their back pain is a top predictor of their recovery.
MRI’s can be helpful in understanding what is going on in our tissue, but often times can tell us more than we need to know or be misleading. I only suggest people obtain an MRI if they have a severe loss of function or conservative treatment has been attempted for at least one year and failed. MRI’s do not need to dictate our treatment but need to be used as an adjunct to patients reports of pain and functional status.
For instance, a study revealed that in a group of people without symptoms, MRIs showed:
36% had herniated discs
21% had spinal stenosis
90% and degenerated or bulging discs
Another study performed MRI’s on non-symptomatic patients and then again after an incidence of low back pain was reported. 84% of the patient’s MRI’s were unchanged or had improved after their injury!
These studies show us that MRI findings do not always go hand in hand with our symptoms. Many times, people allow MRI findings to dictate their feelings and overall outcomes of their back pain.
This does not mean that people with back pain and injuries should be expected/allowed to lift as heavy as they can with no thought. What I am wanting to debunk is the idea that people should avoid ALL lifting and strengthening exercises, when in fact, lifting can and should be a part of low back pain rehab.
What has been so wonderfully proven in a few research articles is exercises, such as the deadlift, when properly taught and dosed, greatly decrease peoples reports of pain, increase their function as well as the quality of life.
What is even more wonderful, the exercises prescribed were at peoples 6-10 rep max weights (they weren’t using your normal colored bands or 2# ankle weights you see in physical therapy), but heavyweights! Imagine that, when we learn proper form, correct bracing and appropriate dosing, lifting heavy can be therapeutic.
Most people will experience low back pain at some point in their lives, so having a better understanding of the nature in treatment will help you if and when that time comes. Don’t allow old thinking (in yourself or your healthcare providers) keep you from moving and living your best. If you have back pain, keep moving! You are not a fragile human. We are resilient and things can get better! Do not allow imaging to scare you into surgery or a procedure prematurely – and as always, lift things. Lift them well, and make them heavy.
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References:
Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990; 72: 403– 408. [Crossref] [Medline] , [Google Scholar]
Welch N, Moran K, Antony J, et al. The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI- defined lumbar fat infiltration and functional cross- sectional area in those with chronic low back. BMJ Open Sport Exerc Med 2015;1:000050. doi:10.1136/ bmjsem-2015-000050 J Orthop Sports Phys Ther. 2015 Feb;45(2):77-85, B1-4. doi: 10.2519/jospt.2015.5021.
Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial. Aasa B1, Berglund L, Michaelson P, Aasa U.